Letter of Intent. Understanding the Chaos: What Counsellors Need to Know About Adult Attention Deficit. Channone Danychuk

Transcription

1 Running head: ADULT ATTENTION DEFICIT Letter of Intent Understanding the Chaos: What Counsellors Need to Know About Adult Attention Deficit Channone Danychuk Campus Alberta Master of Counselling Program Supervisor: Gina Wong-Wylie Date: September 6, 2006

2 Understanding the Chaos: What Counsellors Need to Know About Adult Attention Deficit Issue In this project I intend to address the issue of counsellors understanding and recognition of Adult Attention Deficit Hyperactivity Disorder (ADHD) in the counselling setting. ADHD is marked by an inability to pay attention, impulsivity, and hyperactivity, resulting in ineffective functioning and coping by the individual (Toner, O Donoghue, & Houghton, 2006). ADHD affects an estimated 3-5% percent of the population and was thought to be a condition that affected children which they grew out of with age. What is known now is that 30-70% of children diagnosed with ADHD continue to have issues into adulthood (Kern et al., 1999). Further, many adults are being diagnosed that were not identified as children. As children, these individuals typically struggle with consequential thinking, attending to and subsequently retaining information, impulsivity, and unchanneled energy, and subsequently often receive negative messages from those around them. This can subsequently erode self esteem and contribute to a self concept where they take on the symptoms of the disorder as inherent personality traits. As adults ADHD may continue to go undiagnosed, with the individual simply feeling like he or she is a failure in many areas, or that they need to work extra hard to achieve results similar to their peers. In adulthood, issues tend to manifest in difficulty with time management and priorizing tasks, impatience with situations where they must attend for periods of time, becoming easily bored and needing frequent changes in lifestyle or employment, risk taking behavior, a failure to follow through on commitments, forgetfulness, taking on more than they can handle, and difficulty relating to the needs of others. 2

3 Significance Given the struggles mentioned above, it would appear that these individuals are likely to see issues arise in their lives that require counselling. Thus it seems likely that counsellors will encounter this type of client in their practice. Subsequently this is an issue counsellors need to be apprised of; while much work is done in regard to treating children with ADHD, there is a danger that we as counsellors may miss this diagnosis in adults. Jackson and Farrugia (1997) assert that counsellors must know what to look for and where to look (p. 315) in order to identify ADHD in adults. As well, stigma and societal biases that have become attached to this disorder, largely due to an increase in recognition and diagnosis in children. Subsequent stigma attached to naming their condition can be a deterrent toward recognizing and treating it. Thus a counsellor s ability to clearly explain the condition, its effects, and potential treatments, is paramount in both informing the client and normalizing it for them. Similarly, this topic has potential ethical implications; stigma may affect the effectiveness of counselling if counsellors are reluctant to buy into the existence or significance of ADHD, and subsequently miss this element of a client s life and the contributions and relationships it may have to presenting issues. Many would argue that a diagnosis is irrelevant to the counselling process; that the individual s issues remain the same regardless of their attentional difficulties. Many more would argue that, in fact, ADHD is over-diagnosed, and acknowledging these symptoms in clients only encourages pathologizing these inherent personality characteristics; creating a problem where there isn t one. I, on the other hand, believe that unless underlying issues are acknowledged, counselling can not proceed in a productive fashion that is fair to the client; that to ignore the elephant in the living room is unethical and ineffective. The significant matters in the life of a person who struggles with 3

4 ADHD will be intertwined with the difficulties they have in this regard, and not recognizing the root of these issues would result in a counselling experience that could result in only the superficial symptoms are addressed. Literature There is a great deal of literature recognizing that ADHD is a disorder that often continues into adulthood, that it can present many issues in terms of client s functioning and quality of life, and that this is an important issue for counsellors to subsequently be aware of, and understand, in order to treat effectively. While the main source of treatment for ADHD has been pharmacological in nature, likely contributing to the fear and stigma associated with it, most authors also note that this population is one that is high need in regard to counselling due to interpersonal problems and ineffective coping. Unfortunately, it is also a population that is less likely to be treated effectively because this root issue is missed. The literature emphasizes the importance of counsellors both being aware of the signs and symptoms of this disorder, as well as gaining an understanding of the impact it has on the life of the client and their perceptions and experiences so as to effectively treat their clients. In regard to the experience of ADHD, Jackson and Farrugia (1997) explain that most adult (ADHD) clients have suffered years of feeling demoralized, discouraged, and ineffective because of a history of failure in school, work, family and social domains, and the cumulative effect of such a history can lead to internalization of these negative messages (p. 316). These clients may also present having little or no awareness of, or knowledge about, ADHD. Toner, O Donoghue, and Houghton (2006) sought to elucidate this experience of ADHD adults through semi-structured interviews identifying themes in the individual s experience. Through their work they identified the Chaos (p. 259) that clients experience, and documented the struggles of 4

5 these clients to cope, as well as the continuing difficulties experienced by adults who were not diagnosed as children, to maintain a level of stability, even when treated. When referring to the issues that this population typically present with, an article in the Harvard Mental Health Letter (2002) notes that, while adults with ADHD who grew up with supportive parents and stable backgrounds may not require counselling, that most have failed to learn important skills or are unable to cope (p. 6). That publication notes the importance of counselling in assisting these individuals to understand their condition, learn new skills to compensate for the areas they struggle in, and adjust to increases in functioning that can happen as a result of pharmacological treatment. These clients are in need of a counsellor who can help them understand their condition and the struggles associated with that, as well as one who will address key areas and use appropriate strategies in the counselling setting. Similarly, Bemporad (1998), in her description of the difficulties adults with ADHD experience, notes that these clients often need psychotherapy because they bear many scars from growing up with the disorder and need to learn how to live with it, (p. 1). Young (1999) also asserts that understanding that their problems stem from an underlying neurological basis will be an important step in repairing [their] self esteem, (p. 185), and notes the importance of dispelling erroneous lay-beliefs about ADHD (p. 185). In regard to counsellors awareness and skill level, Jackson and Farrugia (1997) emphasize the importance of mental health professionals having an understanding of Adult ADHD, in order to identify it in clients and use appropriate counselling strategies. They emphasize that in order to treat these individuals effectively, a counsellor must have a clear understanding of the disorder and how it affects the lives of their clients (p.318). This understanding of the issue will assist both the client and counsellor in understanding the 5

6 dynamics in their lives, as well as to formulate strategies for addressing those. It can provide both a stronger therapeutic relationship because the client feels understood, and allow for therapy to address salient topics and do so in a fashion that is meaningful to the client by being consistent with their world view. Method I intend to review the available literature on Adult ADHD in an effort to describe in detail the experience of the client suffering with it from a personal, social, educational, employment, relationship, familial, and peer standpoint. I will also review popular theories as to the origin of ADHD, how it can present, factors that may influence the individual s experience of it, and issues around stigma. I will detail methods for counsellors to challenge themselves and their biases in their assessment of clients, describe the range of issues that may be addressed in a counselling setting, and detail recommended methods of treatment. Implications My project will result in recommendations for counsellors to gain knowledge about Adult ADHD, practice recognizing it s symptoms in the counselling setting, and to truly attempt to understand the experience of the client with ADHD. I will challenge readers to apply this knowledge in their practice to prevent missing this factor that may significantly affect their client s function. This will not only benefit the client in terms of promoting an understanding of their experience and condition, but produce more effective therapy which benefits both the client and counsellor. This will also benefit counsellors in terms of making them more informed and compassionate in their work. Other implications include a reduction in the stigma associated with attention deficit and an increase in understanding for these clients. 6

7 References Attention deficit disorder in adults. (2002, November). Harvard Mental Health Letter, 3-6. Bemporad, J., (1998). Psychotherapy for adults with attention deficit disorder. Harvard Mental Health Letter, 14(12), 1-3. Jackson, B., & Farrugia, D., (1997). Diagnosis and treatment of adults with attention deficit hyperactivity disorder. Journal of Counselling & Development, 75, Kern, R., Rasmussen, P., Byrd, S., & Wittschen, L., (1999). Lifestyle, personality, and attention deficit hyperactivity disorder in young adults. The Journal of Individual Psychology, 55(2), Rosca-Rebaudengo, P., Durst, R., & Dickman, M., (2000). Adult attention deficit hyperactivity disorder and comorbidity. International Journal of Psychiatry in Clinical Practice, 4, Toner, M., O Donoghue, T., & Houghton, S., (2006). Living in chaos and striving for control: How adults with attention deficit hyperactivity disorder deal with their disorder. International Journal of Disability, Development and Education, 53(2), Young, S., (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),